MP40-13: Are Metachronous Bladder Tumors Predictive of Upper Tract Urothelial Carcinoma Recurrence in Patients Treated with Radical or Endoscopic Surgery

Christian Ericson*, Anthony Compton, Bryce Baird, Raymond Pak, Jacksonville, FL

Introduction: Upper tract urothelial carcinoma (UTUC) comprises 5% of urothelial cancers. Treatment with nephroureterectomy or endoscopically with ureteroscopy with dual laser ablation using holmium and neodymium fibers are current management strategies. Regular surveillance for recurrence is performed post operatively with cross sectional imaging or by ureteroscopy. Metachronous bladder tumors are often identified during surveillance and there is paucity of literature defining their role in predicting upper tract recurrence of UTUC.

Methods: Data was collected from a total of 127 patients who were treated for upper tract urothelial carcinoma (UTUC) with either nephroureterectomy or endoscopic management from 2016 to 2020. Patients underwent surveillance for a maximum of 48 months and the rates of upper tract recurrence (ipsilateral or contralateral) were recorded. Patients were separated into groups based on the presence or absence of metachronous bladder tumors (MBT). The rates of upper tract recurrence overall as well as solely in the contralateral kidney were compared in the two groups. A Pearson’s chi-squared test was utilized to determine statistical significance of the two groups. A p-value of 0.05 was set for statistical significance.

Results: Overall, upper tract recurrence occurred in 23 of 127 (18.1%) patients. 35 of 127 (34%) patients developed MBT. Prescence of MBT vs absence of MBT was predictive of overall UTUC recurrence with incidence of 12 of 35 (34%) vs 11 of 92 (12%) (p=0.0035). Presence of MBT vs absence of MBT was also predictive of solely contralateral UTUC recurrence with incidence of 3 of 26 (11.5%) vs 0 of 81 (0%) (p=0.0019).

Conclusions: Identification of metachronous bladder tumors during surveillance for UTUC is predictive of upper tract recurrence. This is applicable to patients who have bilateral renal units being treated with endoscopic management as well as in patients with a solitary kidney after nephroureterectomy. Physicians should be aware of the increased rate of recurrence in these patients when performing surveillance.

Source of Funding: Mayo Clinic Florida